The risk of superficial bacterial, fungal, or viral infections among patients with atopic dermatitis is wellknown by clinicians and is frequently discussed in the literature and in clinical guidance. Consider the relatively recent resurgence of bleach baths as a method to reduce bacterial counts and minimize infection in patients with atopic dermatitis (AD). Less frequently addressed is the relationship between viral pathogens and eczematous dermatoses. For example, molluscum contagiosum may be associated with local eczematous dermatoses that may obscure the lesion(s) of MC.
Molluscum contagiosum is thought to affect two to eight percent of individuals worldwide.1 The disease is more prevalent in children and the immunocompromised. Estimates suggest that in the US, approximately five percent of children are infected in any given year.1 Rates of molluscum as an STD among adults have been on the rise over the past 30 years.1
Molluscum are painless, presenting as single or multiple pink to white papules with a central umbilication. A given lesion may measure up to 5 to 10mm in diameter.2 Smooth, dome shaped lesions are generally skin colored with an opalescent character, with a white, waxy, curdlike core that can be expressed from the lesion with lateral compression.1
An eczematous reaction has been reported to occur surrounding an individual molluscum lesion. One study, though somewhat dated, reported that in 10 percent of cases of molluscum, an eczematous dermatitis develops around the lesions, “but this disappears as the infection resolves.”3
An Eczematoid Reaction Obscuring Molluscum
Recently, a patient presented with an eczematous rash of the anterior aspect of the right forearm and the antecubital fossa. The patient did not have a history of atopic dermatitis, nor was the typical symmetrical presentation of AD noted. The patient reported pruritus but no additional symptoms, including stinging, burning, or pain. Linear, crusting excoriations on the arm indicated scratching by the patient. The patient had no history of contact or allergic dermatitis and denied using any skincare products or OTC medications in this area. Relevant drug allergy history was negative. She was in otherwise good health with no relevant additional dermatologic or systemic health complaints.
The patient was prescribed a barrier repair cream (EpiCeram Emulsion, Promius) for twice-daily application to the site of the dermatitis. She returned for follow- up at 10 days with marked improvement of erythema, crusting, and pruritus. At 21-day follow-up, significant resolution of the dermatatitis was noted. At this time, a molluscum lesion, not previously visible on initial examination was noted. This was treated with physical destruction.
The lesion resolved, and the patient reported no recurrence of the dermatitis. It should be noted that a repeated full skin exam revealed no molluscum elsewhere on the body.
Molluscum may be associated with local eczematous eruptions that can serve to obscure the primary lesion(s). When patients present with a dermatitis mimicking classic atopic dermatitis but without the typical symmetrical presentation, an underlying etiology may be suspected. In such cases where no other cause of the dermatitis (allergen, irritant, etc.) is suggested by the history, it may be reasonable to institute treatment aimed at reducing symptoms of erythema, scaling, and pruritus, such as with a barrier repair cream. Resolution of the dermatitis may reveal an underlying etiology, such as molluscum, that warrants specific treatment.
Dr. Bikowski has served on the speaker's bureau or advisory board or is a shareholder or consultant to Allergan, Coria, Galderma, Stiefel/GlaxoSmithKline, Intendis, Medicis, Promius, Quinnova, Ranbaxy, and Warner-Chilcott.